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Clinical practice guideline improves the treatment of sickle cell disease vasoocclusive pain.

Abstract：

BACKGROUND:Pain is the most common complication of sickle cell disease requiring emergency department (ED) visits and hospitalization. A Clinical Practice Guideline (CPG) to manage acute sickle cell pain offers clinicians a standardized approach for the provision of evidence-based, cost-effective care. After CPG implementation, monitoring of pre-established indicators is a strategy to evaluate progress toward meeting the goal of providing rapid, effective pain relief for patients with acute sickle cell pain. METHODS:A retrospective chart review of patients with sickle cell disease admitted through the ED at Children's Hospital Boston with the primary diagnosis of vaso-occlusive pain was performed for a period before and after implementation of the CPG. Endpoints measured were: use of a validated pain scale, time from ED triage to first dose of analgesic, use of adequate weight-based analgesic dosing, frequency and location of PCA initiation, and time from ED triage to patient controlled analgesia (PCA) initiation. RESULTS:Two hundred sixty three sickle cell pain admissions in 93 unique subjects were analyzed, 51 pre-CPG and 212 post-CPG. Statistically significant improvements in use of pain scale, appropriate weight-based analgesic dosing, utilization of PCA, and time to initiation of PCA were observed. There was not a statistically significant improvement in the percentage of subjects who received their 1st dose of analgesic within 1 hr; however the median time to first analgesic was reduced significantly from 80 to 65 min (P = 0.003). CONCLUSIONS:Implementation of a CPG to manage acute sickle cell pain in the ED improves the ability to deliver timely, effective analgesia to this patient population. Establishing and monitoring internal benchmarks provides a means for ongoing evaluation of the pre-established goals for patient care.

journal_name

Pediatr Blood Cancer

journal_title

Pediatric blood & cancer

authors

Morrissey LK,Shea JO,Kalish LA,Weiner DL,Branowicki P,Heeney MM

doi

10.1002/pbc.21847

subject

Has Abstract

pub_date

2009-03-01 00:00:00

pages

369-72

issue

eissn

1545-5009

issn

1545-5017

journal_volume

pub_type

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Clinical practice guideline improves the treatment of sickle cell disease vasoocclusive pain.